ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these medications could affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to consider the benefits of taking it against the possible risks for the fetus. Doctors don't have the necessary data to give clear guidelines but they can provide information on risks and benefits that assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who took stimulants during early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to reduce any bias.
However, the study was not without its flaws. In particular, they were not able to differentiate the effects of the medication from the disorder that is underlying. That limitation makes it difficult to know whether the small differences observed in the groups that were exposed are due to medication use or confounding by comorbidities. In addition the study did not examine long-term offspring outcomes.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases didn't appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the question of whether to keep or end treatment during pregnancy is one that more and more doctors have to face. These decisions are usually made without clear and reliable evidence. Instead, physicians must consider their own expertise, the experience of other doctors, and the research that has been conducted on the subject.
In particular, the issue of possible risks to the baby can be tricky. A lot of studies on this issue are based on observational evidence instead of controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations, by examining both data on live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies show a neutral or even slight negative effect. In every case, a careful evaluation of the risks and benefits must be performed.
It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In an article recently published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for patients with ADHD. A decrease in medication could also affect the ability to safely drive and perform work-related tasks, which are crucial aspects of everyday life for those suffering from ADHD.
She recommends women who are unsure about whether to continue or discontinue medication due to their pregnancy consider informing family members, friends and colleagues on the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is important to remember that some drugs can pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the child.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The authors of the study didn't discover any link between early medication usage and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies which showed an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the time of pregnancy. The risk increased in the latter stages of pregnancy when a large number of women decided to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely need a caesarean or have an insufficient Apgar after birth and have a baby that needed breathing assistance at birth. However the researchers of the study were not able to eliminate selection bias by limiting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
The researchers hope their research will aid in the clinical decisions of doctors who see pregnant women. The researchers suggest that, while discussing risks and benefits are important, the decision on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors also advise that, while stopping the medication is an option, it isn't a recommended practice because of the high incidence of depression and other mental health issues for women who are expecting or who are recently postpartum. Additionally, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to new routines. As such, many women decide to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medications are absorbed by breast milk in small quantities, so the risk to nursing infant is very low. However, the amount of exposure to medication by the infant can differ based on dosage, frequency it is administered and the time of day the medication is administered. Additionally, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn isn't fully comprehended.
Because of the lack of research, some physicians may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a difficult choice for the patient, who must weigh the benefits of keeping her medication against the potential dangers to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal period.
A growing number of studies have revealed that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are opting to do this. They have concluded through consultation with their physicians, that the benefits of retaining their current medication outweigh any possible risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. adhd medications uk should be an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.